{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Minh Tea","gend":0,"currentgend":"","add":"166 NEWTON ST","city":"FALL RIVER","state":"MA","zip":"02721","dob":"1993-06-29","age":"","mstatus":"","insh":"C0017929000","cliId":"","pno":"7744513493","cno":"","email":"","ename":"","eno":"","pphy":"Michael A Campbell","ppno":"5086721838","pcpadd":"277 Pleasant St, Ste 304","pcpcity":"Fall River","pcpstate":"MA","pcpzip":"02721","pcpcounty":"","pcpid":"","pcpname":"Prima Care, PC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"166 NEWTON ST","madd2":"","madd3":"","mcity":"FALL RIVER","mstate":"MA","mzip":"02721","pcpfaxno":"","pcpnpi":"1376523621","currentgendcomment":"","pphycomment":"","uniqueid":"93966050","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","G9389","F0781","F411","F331","Z87820","S134XXD","M5412","Z0000","Z13220","Z131","Z1331","S060X0S","M999","M25512","D72819","Z79899","M9901","M9902","M9903","M62830","M25531","G8929","M65931","S52501A","S134XXA","S233XXA","S335XXA","M542","M546","S060X0A","M2550","Z113","Z23","J029","M7050","S86912S","S199XXA","S161XXA","V4940XA","M629","S134XXS"],"date":["2026-05-29","2025-07-10","2025-08-25","2026-03-16","2026-03-16","2026-03-16","2025-08-28","2025-10-29","2025-09-02","2025-09-02","2025-09-02","2025-07-11","2025-07-11","2025-07-11","2025-07-11","2025-10-22","2025-10-22","2025-10-29","2025-10-29","2025-10-29","2025-10-29","2026-04-17","2026-03-20","2026-03-12","2026-04-17","2025-07-28","2025-07-28","2025-07-28","2025-07-28","2025-07-28","2025-07-28","2024-07-23","2024-07-23","2024-07-23","2024-07-24","2024-11-20","2024-11-20","2025-04-27","2025-04-27","2025-04-27","2025-06-04","2025-06-04"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","DIVALPROEX SODIUM","","","Select","Select",""],["","","DIVALPROEX SODIUM ER","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","PRAZOSIN HCL","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}